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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209066
Report Date: 08/12/2024
Date Signed: 08/12/2024 03:00:16 PM

Document Has Been Signed on 08/12/2024 03:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PURPOSEFUL RESIDENTIAL CARE: WELLMAN PLACEFACILITY NUMBER:
157209066
ADMINISTRATOR/
DIRECTOR:		VICKERS, TYSON W.FACILITY TYPE:
735
ADDRESS:809 WELLMAN WAYTELEPHONE:
(661) 412-4541
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 5DATE:
08/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:23 PM
MET WITH:Adonica VickersTIME VISIT/
INSPECTION COMPLETED:
03:09 PM
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On 8/12/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required inspection. LPA met with Licensee, Adonica Vickers to complete facility inspection.

Currently there are five (5) residents in placement. All residents were present at time of inspection, three observed to be relaxing in the living room watching television and the other two were in their bedrooms.

Facility tour conducted. Facility observed to be clean, well lit, and a comfortable temperature. Facility has 1 shared bedroom and 3 private bedrooms, all resident bedrooms observed to have required furnishings. Resident bathrooms toured, fixtures observed to be operational during inspection, water temperature measured at 114 degrees F. Both living room and dining room observed to have adequate seating for residents. Kitchen toured, LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for residents. All knives are locked and secured in pantry. Medications observed to be locked and secured in hallway closet. LPA medications to have original labels, and to be administered as prescribed.

All cleaning supplies observed to be locked and secured in garage. Fire extinguisher present with a service date of 5/10/2024. Las Fire drill conducted on 5/20/2024 according to facility records. Smoke detectors and carbon monoxide detectors present and observed operational on date of inspection.

Outside of facility toured. All exits open free of obstruction. Pool is surrounded by a wrought iron fence which is locked and inaccessible to residents. No hazards observed.

No deficiencies cited during today's inspection. Exit interview conducted, a copy of this report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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